What is Ulcerative Colitis?
Ulcerative
colitis is a disease that causes inflammation and sores, called ulcers, in the
lining of the large intestine. The inflammation usually occurs in the rectum and
lower part of the colon, but it may affect the entire colon. Ulcerative colitis
rarely affects the small intestine except for the end section, called the
terminal ileum. Ulcerative colitis may also be called colitis or proctitis.
The inflammation makes the colon empty frequently, causing diarrhea. Ulcers form
in places where the inflammation has killed the cells lining the colon; the
ulcers bleed and produce pus.
Ulcerative colitis is an inflammatory bowel disease (IBD), the general name for
diseases that cause inflammation in the small intestine and colon. Ulcerative
colitis can be difficult to diagnose because its symptoms are similar to other
intestinal disorders and to another type of IBD called Crohn's disease. Crohn's
disease differs from ulcerative colitis because it causes inflammation deeper
within the intestinal wall. Also, Crohn's disease usually occurs in the small
intestine, although it can also occur in the mouth, esophagus, stomach,
duodenum, large intestine, appendix, and anus.
Ulcerative colitis may occur in people of any age, but most often it starts
between ages 15 and 30, or less frequently between ages 50 and 70. Children and
adolescents sometimes develop the disease. Ulcerative colitis affects men and
women equally and appears to run in some families.
What causes ulcerative colitis?
Theories about what causes ulcerative colitis abound, but none
have been proven. The most popular theory is that the body's immune system
reacts to a virus or a bacterium by causing ongoing inflammation in the
intestinal wall.
People with ulcerative colitis have abnormalities of the immune system, but
doctors do not know whether these abnormalities are a cause or a result of the
disease. Ulcerative colitis is not caused by emotional distress or sensitivity
to certain foods or food products, but these factors may trigger symptoms in
some people.
What are the symptoms of ulcerative colitis?
The most common symptoms of ulcerative colitis are abdominal
pain and bloody diarrhea. Patients also may experience
- fatigue
- weight loss
- loss of appetite
- rectal bleeding
- loss of body fluids and nutrients
About half of patients have mild symptoms. Others suffer
frequent fever, bloody diarrhea, nausea, and severe abdominal cramps. Ulcerative
colitis may also cause problems such as arthritis, inflammation of the eye,
liver disease (hepatitis, cirrhosis, and primary sclerosing cholangitis),
osteoporosis, skin rashes, and anemia. No one knows for sure why problems occur
outside the colon. Scientists think these complications may occur when the
immune system triggers inflammation in other parts of the body. Some of these
problems go away when the colitis is treated.
How is ulcerative colitis diagnosed?
A thorough physical exam and a series of tests may be required
to diagnose ulcerative colitis.
Blood tests may be done to check for anemia, which could indicate bleeding in
the colon or rectum. Blood tests may also uncover a high white blood cell count,
which is a sign of inflammation somewhere in the body. By testing a stool
sample, the doctor can detect bleeding or infection in the colon or rectum.
The doctor may do a colonoscopy or sigmoidoscopy. For either test, the doctor
inserts an endoscope—a long, flexible, lighted tube connected to a computer and
TV monitor—into the anus to see the inside of the colon and rectum. The doctor
will be able to see any inflammation, bleeding, or ulcers on the colon wall.
During the exam, the doctor may do a biopsy, which involves taking a sample of
tissue from the lining of the colon to view with a microscope. A barium enema x
ray of the colon may also be required. This procedure involves filling the colon
with barium, a chalky white solution. The barium shows up white on x ray film,
allowing the doctor a clear view of the colon, including any ulcers or other
abnormalities that might be there.
What is the treatment for ulcerative colitis?
Treatment for ulcerative colitis depends on the seriousness of
the disease. Most people are treated with medication. In severe cases, a patient
may need surgery to remove the diseased colon. Surgery is the only cure for
ulcerative colitis.
Some people whose symptoms are triggered by certain foods are able to control
the symptoms by avoiding foods that upset their intestines, like highly seasoned
foods, raw fruits and vegetables, or milk sugar (lactose). Each person may
experience ulcerative colitis differently, so treatment is adjusted for each
individual. Emotional and psychological support is important.
Some people have remissions—periods when the symptoms go away—that last for
months or even years. However, most patients' symptoms eventually return. This
changing pattern of the disease means one cannot always tell when a treatment
has helped.
Some people with ulcerative colitis may need medical care for some time, with
regular doctor visits to monitor the condition.
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1) Drug Therapy
The goal of therapy is to induce and maintain remission, and
to improve the quality of life for people with ulcerative colitis. Several types
of drugs are available.
- Aminosalicylates, drugs that contain
5-aminosalicyclic acid (5-ASA), help control inflammation. Sulfasalazine is
a combination of sulfapyridine and 5-ASA and is used to induce and maintain
remission. The sulfapyridine component carries the anti-inflammatory 5-ASA
to the intestine. However, sulfapyridine may lead to side effects such as
include nausea, vomiting, heartburn, diarrhea, and headache. Other 5-ASA
agents such as olsalazine, mesalamine, and balsalazide, have a different
carrier, offer fewer side effects, and may be used by people who cannot take
sulfasalazine. 5-ASAs are given orally, through an enema, or in a
suppository, depending on the location of the inflammation in the colon.
Most people with mild or moderate ulcerative colitis are treated with this
group of drugs first.
- Corticosteroids such as prednisone and
hydrocortisone also reduce inflammation. They may be used by people who have
moderate to severe ulcerative colitis or who do not respond to 5-ASA drugs.
Corticosteroids, also known as steroids, can be given orally, intravenously,
through an enema, or in a suppository, depending on the location of the
inflammation. These drugs can cause side effects such as weight gain, acne,
facial hair, hypertension, mood swings, and an increased risk of infection.
For this reason, they are not recommended for long-term use.
- Immunomodulators such as azathioprine and
6-mercapto-purine (6-MP) reduce inflammation by affecting the immune system.
They are used for patients who have not responded to 5-ASAs or
corticosteroids or who are dependent on corticosteroids. However,
immunomodulators are slow-acting and may take up to 6 months before the full
benefit is seen. Patients taking these drugs are monitored for complications
including pancreatitis and hepatitis, a reduced white blood cell count, and
an increased risk of infection. Cyclosporine A may be used with 6-MP or
azathioprine to treat active, severe ulcerative colitis in people who do not
respond to intravenous corticosteroids.
Other drugs may be given to relax the patient or to relieve
pain, diarrhea, or infection.
2) Hospitalization
Occasionally, symptoms are severe enough that the person must
be hospitalized. For example, a person may have severe bleeding or severe
diarrhea that causes dehydration. In such cases the doctor will try to stop
diarrhea and loss of blood, fluids, and mineral salts. The patient may need a
special diet, feeding through a vein, medications, or sometimes surgery.
3) Surgery
About 25 percent to 40 percent of ulcerative colitis patients
must eventually have their colons removed because of massive bleeding, severe
illness, rupture of the colon, or risk of cancer. Sometimes the doctor will
recommend removing the colon if medical treatment fails or if the side effects
of corticosteroids or other drugs threaten the patient's health.
Surgery to remove the colon and rectum, known as proctocolectomy, is followed by
one of the following:
- Ileostomy, in which the surgeon creates a small
opening in the abdomen, called a stoma, and attaches the end of the small
intestine, called the ileum, to it. Waste will travel through the small
intestine and exit the body through the stoma. The stoma is about the size
of a quarter and is usually located in the lower right part of the abdomen
near the beltline. A pouch is worn over the opening to collect waste, and
the patient empties the pouch as needed.
- Ileoanal anastomosis, or pull-through operation,
which allows the patient to have normal bowel movements because it preserves
part of the anus. In this operation, the surgeon removes the diseased part
of the colon and the inside of the rectum, leaving the outer muscles of the
rectum. The surgeon then attaches the ileum to the inside of the rectum and
the anus, creating a pouch. Waste is stored in the pouch and passed through
the anus in the usual manner. Bowel movements may be more frequent and
watery than before the procedure. Inflammation of the pouch (pouchitis) is a
possible complication.
Not every operation is appropriate for every person. Which
surgery to have depends on the severity of the disease and the patient's needs,
expectations, and lifestyle. People faced with this decision should get as much
information as possible by talking to their doctors, to nurses who work with
colon surgery patients (enterostomal therapists), and to other colon surgery
patients. Patient advocacy organizations can direct people to support groups and
other information resources. (See For More Information for the names of such
organizations.)
Most people with ulcerative colitis will never need to have surgery. If surgery
does become necessary, however, some people find comfort in knowing that after
the surgery, the colitis is cured and most people go on to live normal, active
lives.
Research
Researchers are always looking for new treatments for
ulcerative colitis. Therapies that are being tested for usefulness in treating
the disease include
- Biologic agents. These include monoclonal
antibodies, interferons, and other molecules made by living organisms.
Researchers modify these drugs to act specifically but with decreased side
effects, and are studying their effects in people with ulcerative colitis.
- Budesonide. This corticosteroid may be nearly as
effective as prednisone in treating mild ulcerative colitis, and it has
fewer side effects.
- Heparin. Researchers are examining whether the
anticoagulant heparin can help control colitis.
- Nicotine. In an early study, symptoms improved in
some patients who were given nicotine through a patch or an enema. (This use
of nicotine is still experimental—the findings do not mean that people
should go out and buy nicotine patches or start smoking.)
- Omega-3 fatty acids. These compounds, naturally
found in fish oils, may benefit people with ulcerative colitis by
interfering with the inflammatory process.
Is colon cancer a concern?
About 5 percent of people with ulcerative colitis develop
colon cancer. The risk of cancer increases with the duration and the extent of
involvement of the colon. For example, if only the lower colon and rectum are
involved, the risk of cancer is no higher than normal. However, if the entire
colon is involved, the risk of cancer may be as much as 32 times the normal
rate.
Sometimes precancerous changes occur in the cells lining the colon. These
changes are called "dysplasia." People who have dysplasia are more likely to
develop cancer than those who do not. Doctors look for signs of dysplasia when
doing a colonoscopy or sigmoidoscopy and when examining tissue removed during
the test.
According to the 2002 updated guidelines for colon cancer screening, people who
have had IBD throughout their colon for at least 8 years and those who have had
IBD in only the left colon for 12 to 15 years should have a colonoscopy with
biopsies every 1 to 2 years to check for dysplasia. Such screening has not been
proven to reduce the risk of colon cancer, but it may help identify cancer early
should it develop. These guidelines were produced by an independent expert panel
and endorsed by numerous organizations, including the American Cancer Society,
the American College of Gastroenterology, the American Society of Colon and
Rectal Surgeons, and the Crohn's & Colitis Foundation of America Inc., among
others.
References:
National
Digestive Diseases Information Clearinghouse
Nutritional and Herbal Therapy for
Ulcerative Colitis
Because many people with UC have nutritional deficiencies due
to malabsorption in the intestines and frequent diarrhea, it is important to
supplement your diet with a multivitamin. The following are supplements that may
help relieve symptoms and reduce occurrence of UC:
- Probiotics may improve symptoms of UC and help
prevent flare-ups. These are the beneficial bacteria the digestive tract.
- Omega-3 Fatty Acids may reduce symptoms of UC and
prevent recurrence of the condition. Recent scientific research shows that
Evening Primrose Oil may also be beneficial for relieving UC
symptoms.
- Psyllium seeds (Plantaginis ovatae) These have
been studies that compared the use of psyllium seeds to the prescription
drug mesalamine in people with UC. They showed that psyllium seeds may be as
effective as the medication in decreasing recurrences of the disease. The
two can also be used in combination.
It is important to increase your intake of fruits and
vegetables and decrease your intake of sugar and fat. This dietary
modification may reduce flare-ups. If you are experiencing a flare-up, a
bland, low-fiber diet is best during this time.
There are some Chinese herbal formulas that may help
reduce the symptoms of UC:
-
Shu Gan Wan
-
Mu Xiang Shun Qi Wan
-
Xiao Yao Wan
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